Revised International Prognostic Scoring System for Myelodysplastic Syndromes by Peter L. Greenberg, Heinz Tuechler, Julie Schanz, Guillermo Sanz, Guillermo Garcia-Manero, Francesc Solé, John M. Bennett, David Bowen, Pierre Fenaux, Francois Dreyfus, Hagop Kantarjian, Andrea Kuendgen, Alessandro Levis, Luca Malcovati, Mario Cazzola, Jaroslav Cermak, Christa Fonatsch, Michelle M. Le Beau, Marilyn L. Slovak, Otto Krieger, Michael Luebbert, Jaroslaw Maciejewski, Silvia M. M. Magalhaes, Yasushi Miyazaki, Michael Pfeilstöcker, Mikkael Sekeres, Wolfgang R. Sperr, Reinhard Stauder, Sudhir Tauro, Peter Valent, Teresa Vallespi, Arjan A. van de Loosdrecht, Ulrich Germing, and Detlef Haase Blood Volume 120(12):2454-2465 September 20, 2012 ©2012 by American Society of Hematology

IWG-PM patients marrow blast subgroups. IWG-PM patients marrow blast subgroups. Impact on survival. Survival related to MDS patients' individual marrow blast percent categories (Kaplan-Meier curves, Dxy 0.3, P < .001). The number of patients in each category and their proportional representation are shown in Table 1. Peter L. Greenberg et al. Blood 2012;120:2454-2465 ©2012 by American Society of Hematology

IWG-PM patients marrow blast subgroups: Impact on AML evolution. IWG-PM patients marrow blast subgroups: Impact on AML evolution. Progression to AML related to MDS patients' individual marrow blast percent categories (Kaplan-Meier curves, Dxy 0.47, P < .001). The number of patients in each category and their proportional representation are shown in Table 1. Peter L. Greenberg et al. Blood 2012;120:2454-2465 ©2012 by American Society of Hematology

Survival based on IPSS-R prognostic risk-based categories. Survival based on IPSS-R prognostic risk-based categories. Survival related to MDS patients' prognostic risk categories (Kaplan-Meier curves, n = 7012; Dxy 0.43, P < .001). The number of patients in each category and their proportional representation are shown in Table 1. Peter L. Greenberg et al. Blood 2012;120:2454-2465 ©2012 by American Society of Hematology

AML evolution based on IPSS-R prognostic risk-based categories. AML evolution based on IPSS-R prognostic risk-based categories. Progression to AML related to MDS patients' prognostic risk categories (Kaplan-Meier curves, n = 6485; Dxy 0.52, P < .001). The number of patients in each category and their proportional representation are shown in Table 1. Peter L. Greenberg et al. Blood 2012;120:2454-2465 ©2012 by American Society of Hematology

Survival based on patient ages > 60 years vs ≤ 60 years related to their IPSS-R prognostic risk-based categories (Kaplan-Meier curves). Survival based on patient ages > 60 years vs ≤ 60 years related to their IPSS-R prognostic risk-based categories (Kaplan-Meier curves). Age-related differential survivals are shown for patients in all groups, particularly for those in lower risk categories. Peter L. Greenberg et al. Blood 2012;120:2454-2465 ©2012 by American Society of Hematology

Age-adjusted IPSS-R risk categories. Age-adjusted IPSS-R risk categories. The nomogram describes predicted survival based on patient age and IPSS-R risk status (IPSS-RA). To determine an age-adjusted risk categorization, for example, follow the horizontal line, starting at the IPSS-R risk score 3.5 on the vertical axis (Int [Intermediate] risk category per Table 4) to the age of the patient and record the color at that point. If the patient is 45 years, the 3.5′-line and the vertical 45-year line cross in the gray field, placing the patient in the Low risk category, whereas if the patient is 95 years the 3.5′-line and the 95-year line cross in the yellow field, placing the patient in the Intermediate risk category. As indicated, for most patients in the Very high risk category there is no change of risk group, whereas for most patients in the lower risk categories there is greater possibility of category change. Note the “dotted” vertical line at 70 years, which is at the median age of the IWG-PM patient cohort from which the basic risk category scores were calculated (ie, without need for age correction for these patients). The formula to generate the age-adjusted risk score in the figure: (years − 70) × [0.05 − (IPSS-R risk score × 0.005)]. Example: For the 45-year-old patient with an IPSS-R risk score of 3.5 (Intermediate risk): (45-70) × [0.05 − (3.5 × 0.005)] = −0.81. Thus, 3.5-0.8 = 2.7 [age-adjusted IPSS-R score, IPSS-RA: Low risk]. Peter L. Greenberg et al. Blood 2012;120:2454-2465 ©2012 by American Society of Hematology

Comparison of IPSS-R and IPSS subgroups within the IWG-PM database patient cohort. Comparison of IPSS-R and IPSS subgroups within the IWG-PM database patient cohort. Vertical axis represents IPSS-R categories' and horizontal axis, IPSS categories. The proportion of patients in each category is shown in Table 9. Kendall τ = 0.73. Peter L. Greenberg et al. Blood 2012;120:2454-2465 ©2012 by American Society of Hematology